MINOR CREDIT SEMINAR

Dr. Adhiraj Mishra, M.V.Sc (1st Year), Div. of Epidemiology
Dr. DK Singh, Principal Scientist, Veter...
MAGNITUDE OF GLOBAL TRAVEL
 International arrivals will
reach 1.6 billion by 2020.

International Tourist (million)

903
...
MODE OF TRAVEL

6%

41%

51%
(UNWTO-2012)
REASON OF TRAVEL

International Travel & Health, 2012
TRAVEL RELATED RISK factors
 Mode of transport.
 Destination.
 Duration and season of travel.

 Purpose of travel.
 B...
AIR TRAVEL & Associated Risks
 Quality of Aircraft cabin






air & HEPA Filter.
Auxiliary Air Unit.
Aircraft Disins...
SEA TRAVEL & Associated Risks
 13 million passengers travel worldwide on cruise ship.

(UNWTO).
 Disease transmission th...
MODES OF DISEASE TRANSMISSION
Routes

Diseases

Food borne &
Waterborne

Traveller’s diarrhoea,
Cholera,
Cryptosporidiosis...
DISEASE DIAGNOSIS BY GEOSENTINEL SITES
Diagnosis

Cases

Malaria

1,762

Giardiasis

1,296

Dengue Fever

888

Campylobact...
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
 Zoonotic viral disease caused by the SARS-CoV.
 By July 2003, 8,273 cases and ...
Contd.
 American businessman who stayed

in the same hotel, now travelling
from China to Singapore had
emergency landing ...
GLOBAL SPREAD OF SARS

The WHO Report, 2003
PANDEMIC INFLUNZA (H1N1)
 “pH1N1", 1st identified in April 2009, and

initially spread in Mexico and then
globally.
 Eme...
AVIAN INFLUNZA (H5N1)
 Avian influenza A (H5N1), first seen in Hong Kong in

1997. Then, it reappeared in Vietnam in 2003...
AVIAN INFLUENZA IN CHINA
 Avian influenza A (H7N9) virus was first reported in

China among human beings and poultry.
 T...
PREVENTION OF RESPIRATORY
INFECTIONS








Frequent washing of hands with
soap & water.
Disinfection
of
household
...
HIV/AIDS and Travel
 HIV-I pandemic started by

mid 70s and 80s spread to
five continents through air
travel, sea travel ...
DRUG RESISTANCE
 MRSA, Strains of N. gonorrhoeae & multidrug resistant

Acinetobacter
travellers.

baumannii

have been

...
Travel of NDM-1
 First detected in patient’s stool

who returned to Sweeden after
hospitalisation in India in Jan
2008.
...
GLOBAL SPREAD OF NDM (June2012)

Ostroff SM, 2012
DENGUE VOYAGE
 In 2000, Dengue spread to the US

via infected travellers.
60

50
40
30
20
10

0
South East
South
Asia
Cen...
CHIKUNGUNYA FLIGHTS
 Restricted to Africa & Asia

and after the Kenya
outbreak in 2004 it
appeared in islands of
Indian O...
WEST NILE VIRUS
The West Nile Virus is
believed to reach United
States in 1999 via mosquitoes
that crossed oceans by aircr...
MASS GATHERINGS (MG)
HAJJ PILIGRIMAGE & DISEASES
Health Requirements
Entry Visa:

for

Yellow Fever-Risk area
Meningococcal Meningitis.

(A,C...
Spread of Emerging Diseases
 MERS-CoV-EMC/2012

a novel
Corona virus first reported on
24th Sept, 2012 in Saudi Arabia.
...
KUMBH MELA
100 million people, 600 km pipes, 92 million litres clean
water/day, 35,000 temporary toilets and 10,000 night ...
SPORTS EVENTS
London Olympic 2012:
 15,000 athletes, 70,000
volunteers,
20,000
journalists
and
10
million spectators.
FIF...
INTERNATIONAL ORGANISATIONS
FOOD AND WATER PRECAUTIONS
 Bottled water.
 Selection of foods
 well-cooked and hot.

 Avoidance of
 salads, raw vege...
VECTOR PRECAUTIONS
 Protective Clothing.
 Insect repellent containing DEET 25 – 50%
 Treatment of outer clothing with
p...
BLOODBORNE DISEASES & STD PRECAUTIONS
Avoid
 Unprotected sexual activity
 Commercial sex workers
 Tattooing and body pi...
INTERNATIONAL HEALTH REGULATIONS, 2005
 Came into force on 15th June 2007.

Their main objectives are to ensure:
(1) Rout...
ANIMAL TRAVEL & DISEASES
Species

Diseases

Bovine

Bovine Spongiform Encephalopathy, CBPP, FMD, BVD.

Equine

Equine Infe...
WHAT TO DO?
 Pre-travel Medical Consultation.
 Strengthening of travel industry.
 Redefine responsibility of the travel...
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Global travel and spread of infections

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Global travel and spread of infections

  1. 1. MINOR CREDIT SEMINAR Dr. Adhiraj Mishra, M.V.Sc (1st Year), Div. of Epidemiology Dr. DK Singh, Principal Scientist, Veterinary Public Health Dr. Bhoj R Singh, Principal Scientist and Head, Division of Epidemiology
  2. 2. MAGNITUDE OF GLOBAL TRAVEL  International arrivals will reach 1.6 billion by 2020. International Tourist (million) 903 940 2007 2010  Travel to developing countries increased from 31 % to 47% and to Asia Pacific and Middle East have doubled in last decade. (UNWTO-2012) 435 1990
  3. 3. MODE OF TRAVEL 6% 41% 51% (UNWTO-2012)
  4. 4. REASON OF TRAVEL International Travel & Health, 2012
  5. 5. TRAVEL RELATED RISK factors  Mode of transport.  Destination.  Duration and season of travel.  Purpose of travel.  Behaviour of the travellers.  Underlying health of the travellers.
  6. 6. AIR TRAVEL & Associated Risks  Quality of Aircraft cabin     air & HEPA Filter. Auxiliary Air Unit. Aircraft Disinsection. Disease transmission: Coughing, sneezing and direct or indirect contact. e.g-TB, Influenza, SARS
  7. 7. SEA TRAVEL & Associated Risks  13 million passengers travel worldwide on cruise ship. (UNWTO).  Disease transmission through: Contaminated food & Water, Whirlpool spa, inhalation. e.g. Gastroenteritis (2006), Influenza & other RTI, Legionellosis (1994) (International Travel & Health, 2012)
  8. 8. MODES OF DISEASE TRANSMISSION Routes Diseases Food borne & Waterborne Traveller’s diarrhoea, Cholera, Cryptosporidiosis, Giardiaisis, Hepatitis A & E, Listeriosis & Typhoid Fever Air borne TB, SARS, Mumps, diptheria, measles Vector Borne Animal Borne Malaria, Yellow Fever, Dengue, Japanese Encephalitis, Chikungunya & Tick borne encephalitis. Rabies, Brucellosis, Leptospirosis Blood borne Hepatitis B & C, HIV/AIDS and Malaria Sexually Transmitted Hepatitis, HIV/AIDS & Syphilis Soil borne Anthrax, Ascariasis, Trichuris, Fungal infections Recreational Water Leptospira, Pseudomanas, Legionellosis, Schistosoma, CLM, Giardia, Cryptosporidium, Tinea & Cutaneous papilloma.
  9. 9. DISEASE DIAGNOSIS BY GEOSENTINEL SITES Diagnosis Cases Malaria 1,762 Giardiasis 1,296 Dengue Fever 888 Campylobacteriosis 596 Cutaneous Larva migrans 577 Rabies P E Prophylaxis 349 Enteric Fever 262 Spotted Fevers 220 Chikungunya 120 Acute Hepatitis A 94 Confirmed Influenza A/B 84 Leader K, Torresi J et al, 2013
  10. 10. SEVERE ACUTE RESPIRATORY SYNDROME (SARS)  Zoonotic viral disease caused by the SARS-CoV.  By July 2003, 8,273 cases and 775 deaths reported in multiple countries (9.6% fatality rate). Within weeks, SARS spread from Hong Kong to 37 countries in early 2003. (WHO)  1st seen- Guangdong Province of China-16th Nov, 2002  Dr. Liu Jianlun reached Hong Kong-21st Feb, 2003  Stayed in Metropole Hotel Room No.911 and shifted to Hospital on 22nd Feb 2003 and died on 4th March
  11. 11. Contd.  American businessman who stayed in the same hotel, now travelling from China to Singapore had emergency landing in Vietnam and died.  Disease spread to Canada, Singapore, China, Vietnam , United States, Mongolia etc.  WHO issued global alert on 12th March 2003.  1st case in India- 32 year man in Goa, who returned from Hong Kong and Singapore on 17th April 2003.
  12. 12. GLOBAL SPREAD OF SARS The WHO Report, 2003
  13. 13. PANDEMIC INFLUNZA (H1N1)  “pH1N1", 1st identified in April 2009, and initially spread in Mexico and then globally.  Emerged from pigs in Asia, and was carried to North America by infected persons.  The first case of the Swine flu in India -on 13 May 2009, when a 23 year old man travelling by Emirates Airline from New York to Hyderabad via Dubai.
  14. 14. AVIAN INFLUNZA (H5N1)  Avian influenza A (H5N1), first seen in Hong Kong in 1997. Then, it reappeared in Vietnam in 2003 and has been in continuous circulation ever since.  H5N1 has primarily affected poultry, from 2003 through 2011, 578 human illnesses in 15 countries were reported, with an alarming case-fatality ratio of 59%.  The countries with the most cases of human disease (Indonesia, Vietnam, and Egypt) account for 80% of all cases and 78% of all deaths. (Ostroff SM, 2012)
  15. 15. AVIAN INFLUENZA IN CHINA  Avian influenza A (H7N9) virus was first reported in China among human beings and poultry.  Till 6th Nov, 2o13, 139 H7N9 human infections were reported & 45 people died. (ProMED-Mail).  Person-to-person spread of H7N9 is rare.
  16. 16. PREVENTION OF RESPIRATORY INFECTIONS       Frequent washing of hands with soap & water. Disinfection of household surfaces. Wear disposable gloves and apron and N-95 mask. Eye protection (e.g. face shield or goggles) if splash or spray of body fluids is likely. Thermal Screening at airport & Quarantine. Social distancing.
  17. 17. HIV/AIDS and Travel  HIV-I pandemic started by mid 70s and 80s spread to five continents through air travel, sea travel and human migration.  Case of ‘Patient Zero’, a Canadian flight attendant who travelled extensively worldwide.  In the United States, the rapid spread of AIDS between 1984 and 1990 can be modelled accurately using air traffic flows between cities. (CDC, Yellow Book 2012)
  18. 18. DRUG RESISTANCE  MRSA, Strains of N. gonorrhoeae & multidrug resistant Acinetobacter travellers. baumannii have been spread (Ostroff SM, 2012) by
  19. 19. Travel of NDM-1  First detected in patient’s stool who returned to Sweeden after hospitalisation in India in Jan 2008.  A total of 37 isolates with NDM-1 were recovered from 50 UK patients and 143 from patients at Indian subcontinent  Since Aug 2010, it has worldwide distribution except in Central and South America.
  20. 20. GLOBAL SPREAD OF NDM (June2012) Ostroff SM, 2012
  21. 21. DENGUE VOYAGE  In 2000, Dengue spread to the US via infected travellers. 60 50 40 30 20 10 0 South East South Asia Central Asia Central America South America Caribbean Sub Saharan Africa Cases of Dengue among travellers (Leader K, Torresi J et al 2013)
  22. 22. CHIKUNGUNYA FLIGHTS  Restricted to Africa & Asia and after the Kenya outbreak in 2004 it appeared in islands of Indian Ocean in 2005 and then reached Indian Subcontinent in 2006.  Travellers to India and Indian visitors then spread it to Europe, North America and Australia having viable vectors.
  23. 23. WEST NILE VIRUS The West Nile Virus is believed to reach United States in 1999 via mosquitoes that crossed oceans by aircraft wheel wells. (CDC Yellow Book 2012)
  24. 24. MASS GATHERINGS (MG)
  25. 25. HAJJ PILIGRIMAGE & DISEASES Health Requirements Entry Visa: for Yellow Fever-Risk area Meningococcal Meningitis. (A,C,Y,W135) Poliomyelitis-Oral Vaccine. Seasonal Influenza. (Weekly Epid. Report, 2013)
  26. 26. Spread of Emerging Diseases  MERS-CoV-EMC/2012 a novel Corona virus first reported on 24th Sept, 2012 in Saudi Arabia.  As on 19th Nov, 2013 157 people affected with 66 deaths. (ProMED Mail)  ‘Sacrifice Voucher’ can spread Meat borne Zoonoses.  Blood Borne Pathogen like Heaptitis B, C and HIV. (Balaban V, Ahmed, Q, 2011)
  27. 27. KUMBH MELA 100 million people, 600 km pipes, 92 million litres clean water/day, 35,000 temporary toilets and 10,000 night soil sweepers. ( Balsari S, 2013)
  28. 28. SPORTS EVENTS London Olympic 2012:  15,000 athletes, 70,000 volunteers, 20,000 journalists and 10 million spectators. FIFA World Cup 2010: South Africa  32 national teams & 3.2 million spectators World Cup Cricket, 2007 Caribbean islands:  16 participating nations and 1 million spectators.
  29. 29. INTERNATIONAL ORGANISATIONS
  30. 30. FOOD AND WATER PRECAUTIONS  Bottled water.  Selection of foods  well-cooked and hot.  Avoidance of  salads, raw vegetables, raw or undercooked eggs and meat.  unpasteurized dairy products  street vendors  Ice. 30
  31. 31. VECTOR PRECAUTIONS  Protective Clothing.  Insect repellent containing DEET 25 – 50%  Treatment of outer clothing with permethrin or etofenprox.  Use of permethrin-impregnated bed net  Use of insect screens over open windows  Air conditioned rooms  Use of aerosol insecticide indoors  Use of pyrethroid coils outdoors 31
  32. 32. BLOODBORNE DISEASES & STD PRECAUTIONS Avoid  Unprotected sexual activity  Commercial sex workers  Tattooing and body piercing  Blood products  Dental and surgical procedures 32
  33. 33. INTERNATIONAL HEALTH REGULATIONS, 2005  Came into force on 15th June 2007. Their main objectives are to ensure: (1) Routine, preventive measures (e.g. at ports and airports) and the use by all countries of internationally approved documents (e.g. vaccination certificates); (2)The notification to WHO of all events that may constitute a public health emergency of international concern; and (3) The implementation of any temporary recommendations should the WHO Director-General have determined that such an emergency is occurring. (International travel & health, 2012)
  34. 34. ANIMAL TRAVEL & DISEASES Species Diseases Bovine Bovine Spongiform Encephalopathy, CBPP, FMD, BVD. Equine Equine Infectious Anaemia, Glanders, Dourine, Equine Infectious Metritis, Infectious Equine Abortion, Piroplasmosis, Equine Influenza, VEE. (AQ&CS, Govt. Of India) Caprine & Ovine Borders Disease, PPR. Swine Nipah Viral Encephalitis, Respiratory Syndrome. Porcine Avain Reproductive & HPAI, LPAI, IBD, New Castle Diseases. •The Livestock Importation Act, 1898. •The Prevention & Control of Infectious and Contagious Diseases in Animal Act , 2009
  35. 35. WHAT TO DO?  Pre-travel Medical Consultation.  Strengthening of travel industry.  Redefine responsibility of the travellers.  Introduction of Travel Health & Mass Gathering Health in Public Health Curriculum.  Medical Insurance of travellers.

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